042117 -
042118 -
042120 - ..
042121 - 1983 Bachelor of Biological Sciences degree from University of
042122 - Southern California
042123 -
042124 -
042125 - 
042126 -
042127 -
042129 - ..
042130 - 1983 Phi Beta Kappa Gloria Anne Tucker was made a member at
042131 - the University of Southern California.
042132 -
042133 -
042134 - 
042135 -
042136 -
042147 - ..
042148 - 2009 Diplomate in Sports Medicine, American Board of Internal
042149 - Medicine - certified for 2009 through 2019. Further lists
042150 - certifications for...
042151 -
042152 - Internal Medicine
042153 - Family Medicine
042154 - Emergency Medicine
042155 - Pediatrics
042156 - Sports Medicine
042157 -
042158 -
042159 - 
042160 -
042161 -
042162 -
042164 - ..
042165 - Kathy and I went for a walk around the block.
042166 -
042167 -
042169 - ..
0422 -
0423 -
0424 - 1140
0425 -
042501 - Returned from the walk. The doctor was still with the other patient.
042502 -
042503 - Looking through reading materials on a table in the reception room,
042504 - found...
042505 -
042506 - Bio-Med Central
042507 - Journal of Orthopaedic Surgery and Research
042508 - Article number: 16 (2017)
042510 - ..
042511 - The temporal effect of platelet-rich plasma on pain and
042512 - physical function in the treatment of knee osteoarthritis:
042513 - systematic review and meta-analysis of randomized controlled
042514 - trials
042515 -
042516 - https://josr-online.biomedcentral.com/articles/10.1186/s13018-017-0521-3#Sec9
042518 - ..
042519 - Published 23 January 2017
042521 - ..
042522 - ISSN: 1749-799X
042524 - ..
042525 - Abstract
042526 - Background
042528 - ..
042529 - Quite a few randomized controlled trials (RCTs) investigating
042530 - the efficacy of platelet-rich plasma (PRP) for treatment of
042531 - knee osteoarthritis (OA) have been recently published.
042532 - Therefore, an updated systematic review was performed to
042533 - evaluate the temporal effect of PRP on knee pain and physical
042534 - function.
042536 - ..
042537 - Osteoarthritis (OA) is a major cause of knee disability
042538 - involving cartilage damage related to an inadequate healing
042539 - response in the inflammatory milieu [1]. Current non-surgical
042540 - treatment modalities include physiotherapy, analgesia,
042541 - non-steroidal anti-inflammatory drugs, and intra-articular
042542 - injections, such as hyaluronic acid (HA), corticosteroids, or
042543 - Ozone, with the purpose of reducing symptoms and improving
042544 - joint function [2?4].
042546 - ..
042547 - In the past decade, there has been an increasing interest in
042548 - the use of autologous growth factors, such as intra-articular
042549 - injections of platelet-rich plasma (PRP) for treatment of knee
042550 - OA [5]. PRP is a fraction of whole blood and prepared by the
042551 - centrifugation of autologous blood, thereby yielding a higher
042552 - concentration of platelets than baseline values. The
042553 - regenerative effect and anti-inflammatory potential of PRP in
042554 - the tissue healing process have led to extensive investigation
042555 - of PRP as a potential treatment for a variety of
042556 - musculoskeletal indications, including OA [6?8].
042558 - ..
042559 - Conclusions
042561 - ..
042562 - Intra-articular PRP injections probably are more efficacious in
042563 - the treatment of knee OA in terms of pain relief and
042564 - self-reported function improvement at 3, 6, and 12 months
042565 - follow-up, compared with other injections, including saline
042566 - placebo, HA, ozone, and corticosteroids.
042567 -
042569 - ..
042570 - This study reviews other studies.
042572 - ..
042573 - Previously on 180105 1630, Doctor Tuckor explained PRP repairs OA
042574 - injuries, which then resolves knee pain, by increasing the body's
042575 - natural production of collagen, which transforms into and thereby
042576 - repairs/regenrates ligaments, tendons, cartilage, muscle cells, and
042577 - fat cells. ref SDS 30 T14I Research found articles supporting this
042578 - analysis. ref SDS 30 I37N and ref SDS 30 6M8N
042579 -
042580 -
042581 -
042582 -
042583 -
042585 - ..
0426 -
0427 -
0428 - 1151
0429 -
042901 - Found report on professional basketball player, Steph Curry, getting
042902 - good results...
042904 - ..
042905 - PRP, stem cell and Warriors G Steph Curry's quick return from
042906 - knee injury
042907 -
042908 - https://www.oregonlive.com/sports/oregonian/john_canzano/2016/04/steph_currys_return_from_mcl_s.html
042909 -
042911 - ..
042912 - Need articles or other source on PRP protocols treating athletes, who
042913 - experience high stress to knees and feet, like Curry and others in
042914 - basketball, Nadal and Federer in tennis, guys in football, soccar,
042915 - baseball.
042916 -
042917 -
042918 -
042919 -
042920 -
042922 - ..
0430 -
0431 -
0432 - 1152
0433 -
043301 - Entered procedure room, removed shoes and socks for examination of
043302 - feet, knees and left elbow.
043303 -
043304 -
043306 - ..
043307 - Develope Scope of Work for 10th Regeneration PRP Injection Treatment
043308 -
043309 - Follow up ref SDS A7 SO4N, ref SDS 93 SO4N.
043310 -
043311 - Gloria read through the letter submitted earlier this morning,
043312 - reported in another record on 190816 0816. ref SDS B4 V54H
043313 -
043314 -
043315 - *** this is a test ****
043317 - ..
043318 - Discussed possible areas for PRP injections...
043319 -
043320 -
043321 - 1. Shoulder left side
043322 -
043323 - Placed feet on gurney and did 10 pushups to test recovery
043324 - since ultrasound guided PRP injections on 190515 1400.
043325 - ref SDS 93 M23O Pushups were done much easier today, than
043326 - previously.
043328 - ..
043329 - Decided not to inject left shoulder again today, primarily because
043330 - want to concentrate on left knee and right elbow, in addition to both
043331 - feet, which will be needed for Half Dome hike scheduled on 190911.
043332 -
043334 - ..
043335 - 2. Elbow right arm
043336 -
043337 - Injured from doing pushups. Have paused pushups the past
043338 - 4 months, but elbow has not recovered.
043340 - ..
043341 - Planned for Doctor Sara Edwards to inject PRP in the elbow
043342 - based on notice she provides this care at VAMCSF, shown in
043343 - the record meeting on 190626 1000. ref SDS B0 B24M
043344 - However, was unable to schedule the work with her. Need
043345 - healthy, functional right elbow for pushups and pull-ups
043346 - building strength to ascend the steel cables getting to
043347 - the top of Half Dome in 3 weeks.
043349 - ..
043350 - Doctor Tucker will inject PRP in right elbow today.
043351 -
043352 -
043354 - ..
043355 - 3. Left knee
043356 -
043357 - There is no longer sensation of femur bone slipping forward
043358 - off the meniscus, when hiking downhill. This indicates 3
043359 - PRP injections below the knee cap (patella) performed on
043360 - 190515 1400. ref SDS 93 TF4H, were effective, reported in
043361 - the letter on 190524 1048. ref SDS 98 CY62
043363 - ..
043364 - Pain in back of left knee subsided after 3 PRP injections
043365 - in back of knee to ACL and PCL on 190515 1400. ref SDS 93
043366 - TQ7K
043368 - ..
043369 - Left knee buckling during hikes has stopped since PRP
043370 - treatment on 190612 1130. ref SDS A7 WS4I
043372 - ..
043373 - Left knee, within a few weeks after PRP on 190612,
043374 - expressed varying pain after 5+ miles on daily hikes.
043375 - Sometimes pain occurs below and occasionally above patella.
043376 - Mostly feel pain within the joint, more severe on the
043377 - lateral meniscus, shown in letter to the doctor earlier
043378 - today on 190816 0816. ref SDS B4 YO94
043380 - ..
043381 - Radiologist's report for xray on 190607 0810, says in part...
043382 -
043383 - Left knee: unchanged medial and lateral femorotibial joint
043384 - space narrowing compatible with moderate osteoarthritis.
043385 - No evidence of acute fracture. Worsening lateral
043386 - subluxation of the patella with patellofemoral osteophytes.
043387 - Trace suprapatellar effusion. New quadriceps insertional
043388 - enthesophyte. ref SDS A5 TB5V
043390 - ..
043391 - Objective for left knee PRP care...
043392 -
043393 - Reduce pain medication, including Glucosamine Chondroitin,
043394 - needed the past few months, reported in the letter today on
043395 - 190816 0816. ref SDS B4 YO94 After prior PRP injections on
043396 - left knee, beginning on 170726, pain medication was not
043397 - needed to aid left knee for 3 - 4 months. Would like to
043398 - extend this to 6 months with treatment today.
043400 - ..
043401 - Doctor Tucker did examination today of the pelvis. She further held
043402 - both legs at the ankles and pulled simultaneously. She noted
043403 - misalignment, and that left leg is now slightly longer than right leg.
043404 - She seemed to indicate these conditions contribute to left knee
043405 - deficits.
043406 -
043421 -
043423 - ..
043424 - The doctor asked again about the history of left knee osteoarthritis?
043425 -
043426 - [On 190819 1247 letter submits this record to Doctor
043427 - Tucker, reporting on 10th PRP treatment. ref SDS B5 V54H
043429 - ..
043430 - In about June 1973, fell 40 feet into a concrete pump station on a
043431 - construction project in West Sacramento. Lucky to survive the fall,
043432 - and missing 2 pumps 3 feet apart. Orthopedic care in those days
043433 - surgically removed torn cartilage. Over the years, reduced meniscus
043434 - suffered increased pressure from running. Pressure on the left knee
043435 - meniscus increased playing tennis beginning in 1985, resulting in
043436 - osteoarthritis (OA). In December 1999, with OA pain 8+ playing
043437 - tennis, Doctor Craig Boulris with the Orthopedic Department at Kaiser
043438 - in Walnut Creek, diagnosed I would need knee replacement in 5 years.
043439 - He recommended trying Glucosamine Chondroitin. However, the pills
043440 - were too big for me to swallow (didn't know at that time I had
043441 - achalasia). Gave up tennis. Millie was diagnosed with cancer in
043442 - 2002. By 2003, I was hiking with her to build up immunity (ANC)
043443 - needed for getting chemotherapy. This minimal hiking effort (3 - 6
043444 - miles per day, 3 - 5 times a week) was very difficult with advancing
043445 - OA pain level 3 - 6. Millie found Glucocamine Chondroitin in liquid
043446 - form at Costco, which I could swallow. It enabled hiking with Millie
043447 - and having only occasional pain level 1 - 2. By 2013, was hiking 11
043448 - miles per day 7 days a week to treat atherosclerosis, discovered in
043449 - 2009, leading to CABG x4 on 091022. Osteoarthritis in left knee
043450 - advanced due to treatment for CVD, which was successful raising
043451 - cholesterol from HDL 30 at the time of heart surgery, to HDL 73. By
043452 - 2017, hiking increased to 11 - 15 miles per day. Earlier on 140805,
043453 - was diagnosed with metatarsalgia caused by fat pad atrophy on the
043454 - balls of both feet. Doctor Tang in Podiatry at VAMCSF tried many
043455 - lines of care to resolve metatarsalgia, so that treatment for CVD
043456 - could continue with hiking. In 2017, suffered plantar plate tear on
043457 - right foot, and Tailor's Bunions on both feet. Research indicated PRP
043458 - injections might be effective for treating all these feet injuries.
043459 - On 190726, Doctor Tucker performed PRP injection procedure on the
043460 - feet. She offered to inject the left knee to evaluate PRP treatment
043461 - for OA. This was effective, and so has continued since then.
043463 - ..
043464 - [...below on 190816 1100 Doctor Tucker's progress notes
043465 - report history of left knee severe injury. ref SDS 0 KX6G
043467 - ..
043468 - [On 190920 1427 letter to Doctor Tucker reports left knee
043469 - pain after not hiking for a week, indicating PRP treatment
043470 - on 190816, had less effect than the year before.
043471 - ref SDS B8 V54H
043473 - ..
043474 - Today, Doctor Tucker diagnosed left knee patella is out of alignment.
043475 - She seemed to say riding a bicycle would strengthen muscles to restore
043476 - alignment. Don't have a bicycle. On 190812 1330, Doctor Kim ordered
043477 - physical therapy for left shoulder. ref SDS B1 4V88 May be able to
043478 - combine PT for left shoulder with riding a stationary bike in Physical
043479 - Therapy. Will ask Mike about this.
043487 - ..
043488 - The doctor decided to focus PRP injections today, on treating left
043489 - knee deficits.
043490 -
043492 - ..
043493 - 4. Right knee
043494 -
043495 - Has responded well to injections on 190403 1000,
043496 - ref SDS 79 GE9L, and to injections on 190612 1100, 190612
043497 - 1130, ref SDS A7 GE9L, Interval hiking has revealed
043498 - intermittant right knee pain.
043500 - ..
043501 - Radiologist's report for xray on 190607 0810, says in part...
043502 -
043503 - "Right knee: Unchanged medial femorotibial joint space
043504 - narrowing with tricompartmental osteophytes compatible with
043505 - moderate osteoarthritis. No evidence of acute fractures.
043506 - Heterotopic ossification of the medial joint line likely
043507 - sequela of prior ligamentous injury. Trace suprapatellar
043508 - effusion. Small quadriceps insertional enthesophyte.
043509 - Surgical clips project over the posterior soft tissue."
043510 - ref SDS A5 TB47
043512 - ..
043513 - The doctor assigned right knee lowest priority for PRP injections
043514 - today.
043515 -
043516 -
043517 -
043518 - 5. Tailor's Bunion right foot
043519 -
043520 - Was treated with PRP injection on 190403 1000. ref SDS 79
043521 - GE5H Since then there has been some pain reported in case
043522 - study on 190101, on some hikes, e.g., on 190713,
043523 - ref SDS 64 VSSS,
043525 - ..
043526 - The doctor will inject PRP to right foot Tailor's Bunion, if available
043527 - at end of other priority injections.
043528 -
043529 -
043531 - ..
043532 - 6. Tailor's Bunion left foot
043533 -
043534 - Was treated with PRP injection 190403 1000. ref SDS 79 9G4I
043535 - There was continuing pain in left foot Tailor's Bunion,
043536 - while hiking, e.g., on 190419 shown in case study on 190101
043537 - 0730. ref SDS 64 SVQX On 190427 pain level 2 - 3 almost
043538 - entire hike. ref SDS 64 UPQT
043540 - ..
043541 - Was treated again with PRP on 190515 1400. ref SDS 93 Q35G
043542 - There was continuing pain in left foot Tailor's Bunion,
043543 - while hiking, e.g., on 190522 shown in case study on 190101
043544 - 0730. ref SDS 64 XWVY
043546 - ..
043547 - On 190612 1130 the doctor injected left foot Tailor's
043548 - Bunion with PRP using ultrasound guidance. ref SDS A7 Q35G
043549 - For a month after PRP injection on 190612, there were some
043550 - hikes when minor pain ( < 3 ) occurred during part of hike.
043551 - For the past 4+ weeks there have no reports of pain in
043552 - left foot Tailor's Bunion.
043554 - ..
043555 - Decided not to inject left foot Tailor's Bunion today.
043556 -
043558 - ..
043559 - 7. Metatarsalgia both feet
043560 -
043561 - PRP was injected between all 5 metatartsals on 190403 1000.
043562 - ref SDS 79 9T4O
043564 - ..
043565 - Feet responded well with no metatarsalgia pain after PRP
043566 - treatment on 190403, so there were no follow up injections
043567 - on 190515 1400. ref SDS 93 0108 There was continuing
043568 - burning sensation bottom right foot, reported in the letter
043569 - to the doctor on 190513 1017. ref SDS 89 SB9M This
043570 - occurred everyday after injections on 190403, with varying
043571 - intensity, e.g., on 190523, shown in case study on 190101
043572 - 0730. ref SDS 64 QL4H
043574 - ..
043575 - PRP was injected between all 5 metatartsals on 190612 1130.
043576 - ref SDS A7 0108
043578 - ..
043579 - Feet have responded well to treatment on 190612, however,
043580 - there have been some hikes when metatarsalgia pain occurs
043581 - in both feet, reported in case study on 190101, e.g., on
043582 - 190629, ref SDS 64 TTTU; again on 190630, ref SDS 64 TTYR,
043583 - also on 190713, ref SDS 64 VSSS, on 190727, ref SDS 64
043584 - XSXV,
043586 - ..
043587 - Feet will experience severe stress hiking Half Dome on
043588 - 190912, especially coming down, explained in hike last year
043589 - on 180912 0545. ref SDS 50 VZ5G
043591 - ..
043592 - The doctor will inject PRP in both feet, as done last year on 190824,
043593 - 3 weeks before hiking Half Dome on 180912.
043594 -
043595 -
043596 -
043598 - ..
043599 - NSAID Pain Medication Paused 7 Days Before PRP Injections
043600 -
043601 - Follow up ref SDS A7 JT6H.
043602 -
043603 - Doctor Tucker noted the report in the letter today, saying Naproxen
043604 - was stopped on 190812, complying with protocol for pausing NSAID
043605 - medications prior to PRP treatment," shown in the record on 190816
043606 - 0816. ref SDS B4 JT9I
043607 -
043608 -
043609 -
043610 -
043612 - ..
0437 -
0438 -
0439 - 1220
0440 -
044001 - Blood Draw for PRP Completed with One Needle Stick
044002 -
044003 - Follow up ref SDS A7 PS4K, ref SDS 93 PS4K.
044004 -
044005 - The doctor drew blood from the left arm, again using the vein on the
044006 - inner elbow, which has been used previously, reported for the 9th PRP
044007 - treatment on 190612 1130, ref SDS A7 PS4K,
044009 - ..
044010 - Kathy assisted, holding the container for the blood draw, and clamping
044011 - the line to change vials. Doctor Tucker aligned the needle and pushed
044012 - it into the vein, shown in the film of this procedure...
044013 -
044014 -
044015 - pix:750 400
044016 - C:\sd\wl\pic\health\190816_PRP_procedure\20190816_122430.mp4
044017 -
044019 - ..
044020 - Video indicates 3 vials of blood were aspirated for centrifuge
044021 - processing to produce PRP.
044023 - ..
044024 - Unclear capacity of each vial. If 3 20 cc vials were used, this
044025 - would be 60 ccs,
044027 - ..
044028 - Gloria said there was good blood flow. After 60 seconds or so, they
044029 - had the 60cc of blood needed for spinning down into 6 or 7 cc of
044030 - platlet rich plasma (PRP). Successful blood draw from same vein 9
044031 - weeks ago, and 4 weeks before that, was aided with running hot water
044032 - over this vein area while showering before leaving for the doctor's
044033 - office, reported above. ref SDS 0 TY9N Blood draw was further aided
044034 - by pushups testing left shoulder and right elbow, also reported above.
044035 - ref SDS 0 ZF6N
044037 - ..
044038 - Took several pictures of the procedure and cleanup...
044039 -
044040 -
044042 - 
044043 -
044044 -
044045 -
044047 - 
044048 -
044049 -
044050 -
044052 - ..
044053 - Identify Injection Sites
044054 -
044055 - Follow up ref SDS A7 O26N, ref SDS 93 O26N.
044056 -
044057 - While PRP was being created using 2-spin Harvest centrifuge
044058 - processing, explained in the doctor's letter on 190419 1123,
044059 - ref SDS 86 V54H, the doctor examined and palpated areas where
044060 - injections would be made. She marked examination findings...
044062 - ..
044063 - Left knee - back of knee...
044064 -
044066 - 
044067 -
044069 - ..
044070 - Elbow right arm...
044071 -
044072 -
044073 - 
044074 -
044075 -
044077 - 
044078 -
044080 - ..
044081 - Left knee...
044082 -
044083 -
044085 - 
044086 -
044088 - ..
044089 - Right knee...
044090 -
044091 -
044093 - 
044094 -
044095 -
044097 - ..
044098 - Both feet were marked between metatarsals...
044099 -
044100 -
044102 - 
044103 -
044104 -
044106 - ..
0442 -
0443 -
0444 - 1300
0445 -
044501 - Numbing Agent and Lidocane Injections Numb PRP Injection Sites
044502 -
044503 - Numbing agent was sprayed on injection sites, which were then further
044504 - numbed with lidocaine injections...
044505 -
044507 - ..
044508 - 
044509 -
044510 -
044512 - ..
044514 - 
044515 -
044517 - ..
044519 - 
044520 -
044522 - ..
044524 - 
044526 - ..
044527 - Antiseptic was applied at each injection site...
044528 -
044529 -
044530 - 
044531 -
044533 - ..
044534 - Injecting lidocaine into the knees is about pain level 2 - noticable,
044535 - but easily tolerated.
044537 - ..
044538 - Injecting lidocaine into Tailor's Bunions on the fore-edge of the foot
044539 - has been pain level 8+ on prior PRP treatments, but today, was only
044540 - about pain level 3, because took oxycodone 3 hours before treatment,
044541 - per above. ref SDS 0 XS8M
044542 -
044543 -
044544 -
044546 - ..
0446 -
0447 -
0448 - 1316
0449 -
044901 - PRP Injections - 24 Total
044902 -
044903 - Follow up ref SDS A7 LO4O, ref SDS 93 LO4O.
044904 -
044905 - After all sites were marked and numbed with spraying agent and
044906 - lidocane, and after the centrifuging process completed, the doctor
044907 - made PRP injections.
044909 - ..
044910 - Left Shoulder Injections
044911 -
044912 - Follow up ref SDS A7 M23O, ref SDS 93 M23O.
044913 -
044914 - Injections......................................... 0
044915 -
044916 -
044917 -
044919 - ..
044920 - Right Elbow
044921 -
044922 -
044923 - Injections......................................... 3
044924 -
044925 -
044927 - 
044928 -
044929 -
044931 - ..
044932 - All pain level 0.
044933 -
044934 -
044935 -
044936 -
044938 - ..
044939 - Trapezius right side
044940 -
044941 - Follow up ref SDS A7 SB5J, ref SDS 93 SB5J.
044942 -
044943 - Injections......................................... 0
044944 -
044945 -
044946 -
044948 - ..
044949 - Right Knee
044950 -
044951 - Follow up ref SDS A7 GE9L, ref SDS 93 GE9L.
044952 -
044953 - Knee joint............................................ 1
044955 - ..
044956 - The doctor seemed to make 1 inta articular injection on lateral side
044957 - of right knee...
044958 -
044959 -
044961 - 
044962 -
044963 -
044965 - ..
044966 - Pain level 0.
044967 -
044968 -
044969 -
044970 -
044972 - ..
044973 - Left Knee
044974 -
044975 - Follow up ref SDS A7 TF4H, ref SDS 93 TF4H.
044976 -
044977 - Knee joint............................................ 8
044979 - ..
044980 - The doctor seemed to make 4 injections on lateral side of left knee,
044981 - including intra articular into the meniscus...
044982 -
044983 -
044985 - 
044986 -
044988 - ..
044990 - 
044991 -
044993 - ..
044995 - 
044996 -
044998 - ..
044999 - All pain level 0, except intra articular injection into lateral
045000 - meniscus was pain level 5, seemed to be deeper into the joint today.
045001 -
045002 -
045004 - ..
045005 - Seemed to be 3 injections below patella on front of knee...
045006 -
045007 -
045009 - 
045010 -
045012 - ..
045013 - All pain level 0.
045014 -
045015 -
045016 -
045018 - ..
045019 - Seemed to be 1 intra articular injection into medial meniscus of left
045020 - knee...
045021 -
045023 - ..
045025 - 
045026 -
045027 -
045029 - ..
045030 - Pain level 0.
045031 -
045032 -
045033 -
045035 - ..
045036 - Back of knee ACL and PCL............................... 3
045037 -
045039 - ..
045041 - 
045042 -
045044 - ..
045046 - 
045047 -
045048 -
045050 - ..
045051 - All pain level 0.
045052 -
045053 -
045054 -
045056 - ..
045057 - Right Foot
045058 -
045059 - Follow up ref SDS A7 0108, ref SDS 93 0108.
045060 -
045061 - Metatarsalgia
045062 - Between little toe and ring toe................. 1
045063 - Between ring toe and middle toe................. 1
045064 - Between middle and long toe..................... 1
045065 - Between long toe and big toe.................... 1
045066 -
045068 - ..
045069 - 
045070 -
045071 -
045073 - ..
045074 - All pain level 2.
045075 -
045076 -
045077 -
045079 - ..
045080 - Tailor's bunion................................. 1
045081 -
045082 -
045084 - 
045085 -
045087 - ..
045088 - Pain level 4. Much easier to tolerate today, after taking hydrocodone
045089 - 3 hours before injections, per above. ref SDS 0 XS8M
045090 -
045091 -
045093 - ..
045094 - Total right foot............................... 5 5
045095 -
045096 -
045097 -
045099 - ..
045100 - Left Foot
045101 -
045102 - Follow up ref SDS A7 YY3G, ref SDS 93 YY3G.
045103 -
045104 - Metatarsalgia
045105 - Between little toe and ring toe................. 1
045106 - Between ring toe and middle toe................. 1
045107 - Between middle and long toe..................... 1
045108 - Between long toe and big toe.................... 1
045109 -
045111 - ..
045112 - 
045113 -
045114 -
045116 - ..
045117 - All pain level 2.
045118 -
045119 -
045121 - ..
045122 - Tailor's Bunion................................. 0
045123 -
045125 - ..
045126 - Total left foot................................ 4 4
045127 -
045129 - ..
045130 - Total PRP injections.................................. 24
045131 -
045132 -
045134 - ..
045135 - Doctor Tucker said to wait about 5 days, before doing pushups, then
045136 - buildup gradually over several weeks, rather than starting out dong 20
045137 - or 30 pushups.
045138 -
045158 - ..
045159 - Did not schedule another PRP treatment. Hope treatment today,
045160 - combined with prior 3 treatments beginning on 190403, will last until
045161 - after January 2020.
045162 -
045163 -
045184 -
045185 -
045186 -
045187 -
045188 -
045189 -
045190 -
045191 -
0452 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Progress Notes Doctor Tucker PRP Procedure on 190403
050403 -
050404 - Follow up ref SDS A7 JS8O, ref SDS 93 JS8O.
050405 -
050406 - Received letter from Doctor Tucker transmitting her Progress Notes for
050407 - the procedure today, shown on 190826 1748. ref SDS B6 V54H
050408 -
050409 - [On 190830 1118 letter submits Doctor Tucker's progress
050410 - notes on 190816, performing PRP injection treatment on feet
050411 - and knees. ref SDS B7 HE4K
050413 - ..
050414 - Stored Doctor Tucker's Progress Notes in...
050415 -
050416 - F:\05\00003\SM\CC\AGMJ\20190816-110000\PRP_aug16_2019x.docx
050418 - ..
050419 - 1. Gloria Tucker MD
050420 - Diplomatic American College of Sports Medicine
050421 - 250 Bel Marin Keys Boulevard, Building G Suite 1
050422 - Novato, CA 94949
050423 - 415 506 4907
050424 - NPI:1265516231
050426 - ..
050427 - Rod Welch
050429 - ..
050430 - 2. Date....................................... August 16, 2019
050432 - ..
050433 - 3. S: Return visit. Since last PRP treatment to knees and feet
050434 - on 2019 06 12, he denies pain in right knee. Sensation of left
050435 - leg femur bone slipping forward off the knee hiking downhill
050436 - has resolved. Left knee intermittent buckling during hikes has
050437 - resolved. He complains beginning about 4 weeks ago, pain
050438 - recurred in left knee meniscus and patella after hiking over 5
050439 - miles, initially going downhill. After 7 - 8 miles knee pain
050440 - occurs on flat ground, but resolves to pain level 0 going
050441 - uphill. Sensation of burning feet has resolved. Left foot
050442 - Tailor's Bunion pain level 0. Beginning about 2 weeks ago,
050443 - mild pain recurred on balls of both feet after hiking more than
050444 - 8 miles. Tailor's Bunion right foot has recently expressed
050445 - pain level 2 after 10 miles. Rising pain dynamics impede
050446 - extended hikes over 11 miles. Beginning 3 or 4 weeks ago,
050447 - patient resumed Glucosamine Chondroitin for knees, prescribed
050448 - by Kaiser years ago, and complemented with pain medication.
050449 - Patient keeps a chart showing he alternates naproxen,
050450 - hydrocodone, oxycodone provided by the VA. He also reports
050451 - pain in his right elbow when he does push-ups. The pain is at
050452 - the lateral aspect of his elbow.
050454 - ..
050455 - X-ray study performed by the VA on 2019-06-07, found unchanged
050456 - medial and lateral femorotibial joint space narrowing
050457 - compatible with moderate osteoarthritis. Worsening lateral
050458 - subluxation of the patella with patellofemoral osteophytes.
050459 - Review of xray in clinic found joint space narrowing of lateral
050460 - meniscus, and retropatellar osteoarthritis consistent with
050461 - patient left knee pain symptoms.
050463 - ..
050464 - 4. Examination: Right knee: No effusion, negative Lachman,
050465 - nontender along the joint line. Right foot: An TTP along his
050466 - 5 MTP joints. Minimal tenderness at his tailor's bunion on
050467 - the right. Left knee: TTP at the posterior medial joint line,
050468 - positive crepitance on hyperextension, positive grind test.
050469 - He describes pain at the inferior aspect of his patella and at
050470 - the anterior aspect of his tibia and the lateral aspect of his
050471 - tibia. Left foot: An TTP along the MTP joints. Right elbow:
050472 - Nontender but he describes discomfort and clicking intra-
050473 - articularly. In the supine position: His left medial
050474 - malleolus is inferior to his right. Seated forward bend shows
050475 - motion of his left PSIS. He is tender in the right AIIS.
050476 - Using a very gentle OMT technique, we realigned his pelvis
050477 - such that his malleoli was equal and symmetric.
050479 - ..
050480 - 5. Of note: the left knee suffers degenerative arthritis after
050481 - cartilage was removed in a procedure in 1973, resulting from
050482 - an industrial accident falling 40' into a pump station landing
050483 - on concrete surface. OA worsened over the years from extreme
050484 - sports activity - running, sprinting, changing directions.
050485 - This was stopped beginning in the year 2000, on advice from
050486 - Kaiser Orthopedics. Interim activity of hiking reduces
050487 - pressure on meniscus and aids in the health of knees. In
050488 - 2013, patient was advised by VA Endocrinology that extended
050489 - endurance hiking improves cardiovascular health by raising
050490 - cholesterol to HDL > 60 in order to regress atherosclerotic
050491 - plaque in blood vessels. The patient had HDL 30, which caused
050492 - CVD and so required CABG x4 at the VA in San Francisco on 2009
050493 - 10 22. Patient increased daily hiking to an extreme level.
050494 - This raised HDL to 83 on 11/12/2018. Coronary CT angiography
050495 - test at that time showed elevated HDL regressed plaque in his
050496 - blood vessels. VA Cardiology progress notes for examination
050497 - on 2018 10 31, report patient is "super fit."
050499 - ..
050500 - This aligns with patient report during the meeting today, on history
050501 - of left knee injury, shown above. ref SDS 0 EG4G
050502 -
050503 - [On 190920 1427 letter to Doctor Tucker reports left knee
050504 - pain after not hiking for a week, indicating PRP treatment
050505 - on 190816, had less effect than the year before.
050506 - ref SDS B8 V54H
050508 - ..
050509 - Hiking to maintain cardiovascular health impacts knee OA
050510 - adversely. Equally, it degrades fat pads on bilateral feet,
050511 - with consequent pain from metatarsalgia injuries. Patient
050512 - seeks PRP treatments to repair these common "wear and tear"
050513 - deficits in order to maintain cardiovascular health.
050515 - ..
050516 - 6. Plan: Patient would like PRP to his bilateral knees, bilateral
050517 - feet and right elbow. Patient advised that losing 10+ pounds
050518 - would reduce pressure on left knee oa, which may extend
050519 - effectiveness of PRP care.
050521 - ..
050522 - Gloria Tucker, MD
050524 - ..
050525 - 7. Procedure: 60 cc were aspirated from his left antebrachial
050526 - fossa. And using sterile technique, we numbed the above areas:
050527 - Right knee intra-articular injection site, right foot: Entry
050528 - sites for MTP joints 1 through 5 as well as intra-articular
050529 - tailor's bunion entry site. Left foot entry sites for MTP
050530 - joints 1 through 5, left knee: Intra-articular entry site
050531 - distal pole the patella anterior tibia lateral joint line
050532 - posterior medial joint line and entry sites of the PCL
050533 - posteriorly bilaterally, right elbow: Intra-articular entry
050534 - site, entry sites for annular ligament of the radial. Then
050535 - after buffering and activating his PRP, we treated the above
050536 - areas with PRP. He tolerated the procedure well.
050538 - ..
050539 - Gloria Tucker, MD
050540 -
050541 -
050542 -
050543 -
050544 -
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050546 -
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050550 -
050551 -
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0506 -